Frequency of serious bacterial infection among febrile sickle cell disease children in the era of the conjugate vaccine: A retrospective study

BACKGROUND: Sickle cell disease (SCD) is a wide prevalence disease worldwide. It has a spectrum of clinical manifestations. However, SCD patients are more susceptible to have a serious bacterial infection (SBI) as compared to other individuals. OBJECTIVE: The main objective of this study was to investigate the prevalence rate of serious bacterial infection (SBI) in febrile children with sickle cell disease (SCD), whose vaccinations are up to date and are on regular penicillin prophylaxis, presented to the emergency department (ED) to assist in the management approach of such patients. METHODS: A retrospective study included febrile SCD children under 12 years of age between 2014 and 2019 at King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. Patients were stratified according to the true culture result of each febrile event. Descriptive statistics were used to report data from the patient's medical records. RESULTS: From 833 febrile events, 40 events were assessed for eligibility with positive culture results. Of these, 10 were excluded due to contamination. The rest, 30 children with confirmed SBI (3.6%, 30/833) (95% CI = 2.4%–5.1%) were recruited. The highest prevalence rate of SBI was for urinary tract infection (UTI) (2.2%, 19/833) (95% CI = 1.4%–3.5%), followed by bacteremia (1.3%, 11/833) (95% CI = 0.7–2.4), osteomyelitis (0.24%, 2/833) (95% CI = 0.03–0.86) and meningitis (0.12%, 1/833) (95% CI = 0.00–0.67). Pneumococcal was the most common isolate among children with bacteremia (46%, 5/11) followed by Salmonella species (36%, 4/11). All the children fully recovered. CONCLUSION: As the prevalence of SBI, particularly bacteremia, continues to decline with a favorable outcome in our population, ambulatory management practices for well-presented febrile SCD children should be encouraged, for there are no further reasons for admission and the patient can return soon to their hospital if his condition worsens or there is growth in the blood culture. Further effort is needed to determine whether blood culture and empiric antibiotics are necessary for each febrile event in the probable highly active vaccination era.